Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Child #1 Name *

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #2 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #3 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #4 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

I would like to cover all of the $30/child or some of the cost for my child to attend VBS. Payments of cash, check, or card may be paid during the week of VBS. *

All

A portion

I am requesting a scholarship to cover the costs. (No additional form necessary.)